Wound Cleansing Research Articles

Nurses' wound care competency in a sample of hospitals in Northern Vietnam

This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses. A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care. A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans. The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.

Emergency Treatment of Soft Tissue and Dentoalveolar Fractures using Risdon Wiring in Children due to Motorcycle Accident : Case Report

Introduction: Dentoalveolar fractures are often found in children due to physical trauma, falls, and motorized accidents. In pediatric patients, there are variations in age, jaw development, and dentition which are the primary considerations in choosing a dentoalveolar fracture treatment method. This case report aims to describe and discuss the emergency management of soft tissue injuries and mandibular dentoalveolar fractures with Risdon wiring in pediatric patients due to motorized accidents. Case report: A 9-year-old female patient complained of bleeding from the mouth due to a traffic accident. Clinical and radiographic examination showed dentoalveolar segment fractures in tooth region 32-42, stab wounds, and lacerations on the inferior lip, vestibule, and gingiva in tooth region 32-42. The patient underwent wound cleaning, wound suturing, and treatment of dentoalveolar fractures with fixation using Risdon wiring in the mandibular region 36-46. Conclusion: Conservative treatment of dentoalveolar fractures in pediatric patients with minimal intervention can give good results. Risdon wiring as a fixation method can be used in the emergency treatment of dentoalveolar fractures in pediatric patients with mixed dentition. Keywords: Soft tissue trauma, dentoalveolar fracture, Risdon wiring, emergency

SG-APSIC1092: Bundled preoperative preparation reduced surgical-site infections

Objectives: We aimed to reduce the overall surgical-site infection (SSI) rate to 0.2%. Methods: A new checklist protocol was developed based on the APSIC guidelines. The bundle for preoperative preparation was implemented: adequate preoperative bathing, proper time of hand-forearm washing, and sufficient contact time of antiseptic application. The compliance rate was monitored with a weekly control chart from December 2019 to November 2020. Results: In total, 9,995 cases were operated at Narasuan University Hospital (NUH) in 2020, classified by surgical wound type as follows: clean wound, 62.6%; clean-contaminated wound, 32.1%; contaminated wound, 0.8%; and dirty wound, 4.5%. According to surgical wound type, the mean compliance with preoperative bathing was 68.22% for clean wounds, 68.33% for clean-contaminated wounds, and 34.82% for contaminated wounds. Hand hygiene preparation compliance was higher for clean wound surgeries (mean, 94.01%) and clean-contaminated wound surgeries (mean, 95.05%) than for contaminated wound surgeries (mean, 88.30%). A high percentage was achieved by the 3 groups. The rate of skin antiseptic preparation compliance was higher in the clean wound group (mean, 89.05%) and the clean-contaminated wound group (mean, 90.70%) than the contaminated wound group (mean, 68.12%). The lower rate might be due to time constraints in contaminated wound operations. Only 0.18% of clean-wound operations had SSIs, and the clean-contaminated wound group had 0.19% SSIs, whereas no SSIs occurred in the contaminated and dirty wound groups. The overall SSI rate was 0.17%; thus, we achieved our goal. Conclusions: A bundle of preoperative infection-prevention preparations reduced the rate of SSI. Furthermore, the bundle had a highly tangible positive impact for both internal and external stakeholders, and it was effective in ensuring good practice regarding preoperative preparation.

SG-APSIC1109: Redesign of outpatient clinic clean care to decrease postoperative SSIs after orthopedic implants

Objectives: Based on Sardjito Hospital surveillance data in 2020, the incidence of SSI in orthopedic implant surgery was 46 cases (4.7%), mostly in the outpatient clinic. We evaluated some of the potential risks and proposed redesign of infection prevention and control measures in April 2021 to improve the overall clean care at the orthopedic outpatient clinic. Methods: We conducted an operational study to redesign various components of clean care using a before-and-after evaluation of infection risk. The study was led by an IPC nurse and was supported by all levels of stakeholders at Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, during May–September 2021. Results: The redesigned components covered continuing professional development (CPD) through a workshop on clean care and wound care for doctors and nurses. The workshop also encouraged high-level management to make several important changes: (1) to redistribute medical staff schedules, (2) to start online patient registration to better distribute and decrease patient loads, (3) to set up the waiting room as well as the dressing room with strictly separate between dirty and clean areas, (4) to schedule daily general disinfection at noon during service hours, and (5) to perform routine air disinfection after daily clinic services as well as placing an additional portable HEPA filter for continuous air disinfection. After the these changes, during 2021, 7 SSIs occurred among postoperative orthopedic implant patients, a decrease of 85%. We observed more clean and neat rooms without patient overcrowding as well as easy and comfortable flow of patients and staff. Environmental pathogen germ counts decreased significantly. Conclusions: A redesign project at the orthopedic outpatient clinic reduced the incidence of postoperative SSIs and reduced the number of environmental pathogens. Overall clean care is a basic strategy in IPC for improving patient safety.

Tracheal injury from dog bite in a child

BackgroundDog bites associated with the head and neck area in children are a common problem. Most of the lacerations are found in the upper lip and the nose region, and tracheal injury is rare [1]. Tracheal injury requires prompt and accurate diagnosis and treatment to rescue the patient. Especially in children, securing the airway is often more difficult than in adults because of their short neck and narrow trachea. In this report, we experienced a pediatric case of multiple dog bites with tracheal injuries in the neck.Case presentationWe report the case of a 3-year-old girl who presented with multiple dog bites. There were multiple wounds on the head, face, neck, and anterior chest, and air leakage was observed from the cervical wound at the time of transfer. It was difficult to perform oral endotracheal intubation, therefore, we extended the neck wound, probed the trachea with finger, and inserted a tracheal tube directly from the cervical wound in the emergency room. Tracheoplasty and another wound cleansing were performed in the operating room. The patient was discharged on the 18th day after surgery, without further complications.ConclusionTracheal injury from a dog bite is rare. It is important to prompt and accurate diagnosis and treatment. Children should be especially careful because of their short necks and narrow tracheas.

Rotation Flap Closure of Pressure Injuries Following Negative Pressure Wound Therapy With Instillation for Wound Cleansing

Introduction. Wound cleansing is integral during early-stage wound management and affords the transition to modalities promoting granulation tissue formation and reepithelialization, or preparation for wound coverage/closure. NPWTi-d includes periodic instillation of topical wound cleansing solutions and negative pressure for infectious material removal. Materials and Methods. This was a retrospective study of 5 patients who were admitted to an acute care hospital and treated for PI. After initial wound debridement, NPWTi-d instilled normal saline or HOCl solution (40 mL–80 mL) onto the wound for a dwell time of 20 minutes followed by 2 hours of subatmospheric pressure (−125 mm Hg). NPWTi-d duration was 3 to 6 days with 48-hour dressing changes. Results. NPWTi-d helped cleanse 10 PIs in 5 patients (age, 39–89 years) with comorbidities to facilitate primary closure using rotation flaps. In 4 patients, rotation flap closures were performed without immediate postoperative complications, followed by hospital discharge within 72 hours. In one patient, closure was preempted due to an unrelated medical issue. A stoma was created to prevent further contamination. The patient returned for flap coverage post colostomy. Conclusion. The findings herein support the use of NPWTi-d in the cleansing of complex wounds and suggest that it may facilitate an expedited transition to rotation flap closure for this wound type.

SURGICAL SITE INFECTIONS IN CLEAN AND CLEAN CONTAMINATED WOUNDS A PROSPECTIVE STUDY

Background – clean wounds include those in which no infection is present; only skin microora potentially contaminate the wound. Clean contaminated wounds Include those in which a hollow viscus such as respiratory, alimentary or genitourinary tracts with indigenous bacterial ora is opened under controlled circumstances without signicant spillage of contents. This study hopes to compare surgical site infection in two types of wounds as well as most common organism causing surgical site infection. After explaining the patients regarding the study Methodologydesign, patients giving informed consent were enrolled for the study. All the patients were assessed pre-operatively by taking relevant detailed clinical history, examination and all investigations and work-up required prior to surgery. At the end of surgery, standard closure protocol was followed. Cleaning the open wound with normal saline followed by skin suturing, followed by application of spirit - normal saline - dry gauze; followed by occlusive type of dressing. Wound was opened for dressing on the 3rd post-operative day, unless there are local/systemic signs of inammation or soakage. Sterile cotton swabs will be obtained from the depth of wounds showing signs and symptoms of SSI and were sent for culture and sensitivity and antibiotics were started accordingly. Presence Results- of diabetes mellitus is a signicant risk factor for causing surgical site infection in clean contaminated wounds (p<0.05) whereas presence of diabetes mellitus is not a signicant risk factor for causing surgical site infection in clean wound (p>0.05). Presence of drain/implant is a signicant causative factor for both clean and clean contaminated wounds (p<0.05). Presence of hypertension is not a signicant causative factor for clean wound (p>0.05) as well as clean contaminated wound (p>0.05). According to this study the rate if surgical site infection in clean w Conclusion- ounds is 6.66% and in clean contaminated wounds is 12%.

A STUDY ON INCIDENCE OF SURGICAL SITE INFECTION AND ITS OUTCOMES IN PATIENTS UNDERGOING LAPAROTOMY- A PROSPECTIVE OBSERVATIONAL STUDY

Aim: To determine the incidence of surgical site infection (SSI) and associated risk factors in laparotomy. Method: Fifty patients who underwent laparotomy were studied for a period of 2 years. The patients were studied by interviewing and examination. Result:The overall SSI incidence was 18% (9/50). Factors like wound class (dirty > clean wound), increased surgical duration were involved. Staphylococcus was found to be the common organism causing SSI. Conclusion: SSI can be reduced by appropriate antibiotic administration, preoperative patient preparation, reducing the duration of surgery, intraoperative asepsis maintenance.

Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

Tissue sampling technique for diabetic toe amputations: a survey of current UK practice

Background: The management of diabetic foot disease remains a challenge for clinicians. Outcomes are improving with the development of integrated diabetic foot teams. Understanding tissue sampling/processing and a standardised evidence-based approach would help develop integrated pathways to improve patient care and outcomes.research priorities. This paper presents the results of this process. Aims: In collaboration with the Vascular Research and Innovation Consortium (VaRICS), this study aimed to evaluate the knowledge base of UK vascular consultant surgeons regarding sampling and processing techniques for diabetic foot disease. Methodology: An online questionnaire was designed to assess consultants' knowledge levels of surgical techniques, infection control, placement of interventions, sampling techniques and processing. This was then distributed to vascular surgery consultants via the Vascular Society of Great Britain and Ireland (VSGBI) email newsletter. Results: 109 consultants participated in this study, of which 63 (58.9%) had a sub-specialist interest in diabetic foot disease. Only 21 (19.6%) consultants had received formal training in bone sampling techniques. Eighteen (62.1%) of the respondents reported having received training at the departmental level. An average of 10–20 toe amputations were performed per month in most units. In 37% of cases, samples from clean bone were always taken after wound cleaning and debridement following toe amputations. A majority of samples from toe amputations consisted of proximal bone (64.5%), pus swabs (51.4%) and tissue/toe resections (45.8%). Most of the contamination reduction measures included saline washing and changing

Early Exposure vs Delayed Exposure of Postoperative Wounds in Elective Inguinal Hernia Surgery: A Longitudinal Study

Introduction: Wounds and their management are fundamental aspects of the practice of surgery. A closed wound that heals in a timely fashion is considered to be a good indicator of surgical intervention. Many experimental studies have shown that precisely sutured incision with good haemostasis gets sealed with fibrin within 6 to 24 hours and the wound becomes adequately protected from outside moisture. Hence, early exposure to clean surgical wounds would be a cost-effective measure, especially in a resource-poor country like ours by avoiding unnecessary dressings for a long period of time. Aim: To assess the effectiveness of early exposure (24 hours) and delayed exposure (72 hours) in wound management after elective inguinal hernia surgery. Materials and Methods: A longitudinal study was conducted in the Department of General Surgery of Government Medical College, Kottayam, Kerala, India from September 2020 to August 2021. All elective cases (n=200) posted for inguinal hernia of age more than 18 years were consecutively allocated to two groups, group A early exposure of surgical wound site and group B delayed exposure. The wound site examination, on the third day along with white blood cell count was assessed. Wound site examination on 7th day and 30th postoperative day and length of hospital day were recorded. Southampton wound grading system was used for recording healing parameters. All data was described using means for continuous variables and percentages for categorical variables Chi-square test was used for categorical variables with significance level at p<0.05. Results: Out of the 200 patients studied, 92 (92%) were males in group A and 94 (94%) of them were males in group B. The wound contamination in those patients where postoperative dressing was removed after 24 hours (group A) and 72 hours (group B), it was found that majority of patients had wound Grade-0 irrespective of dressing i.e., 96% and 97%, respectively (p-value=0.395) with reference to wound condition on postoperative day 7. In group A patients had (96 cases in 0-10 days) compared to group B (97 cases in 0-10 days) although statistically, it was not significant (p-value >0.05). Conclusion: There is not much difference in wound healing and incidence of surgical site infection in patients, whose wounds were kept open 24 hours after surgery when compared to those, whose wounds were dressed daily for the next two days consecutively.

SJLA_2024_A14: Five-year Outcome of Laparoscopic Ventral Hernia Repair with Phasix ST

Background: Repair of ventral and incisional hernias repair (VIHR) is a standard procedure; newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. Indeed the data of Phasix resorption started to occur postmaturation of the wound tissue. However, data on the use of slowly resorbable mesh materials remain scarce, and this study aims to evaluate the use of Phasix ST in the laparoscopic repair of VIHR. Methods: This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a Phasix ST mesh. Perioperative characteristics and clinical outcomes were collected. Results: In total, 26 patients, including 19 females and 7 males, underwent laparoscopic VIHR using Phasix ST from April 2016 to January 2023. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6 years, and the mean body mass index was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in the clinic with a median follow-up of 48 months. We observed four wound seromas, no wound infections, and three recurrences during the 5-year follow-up period. All occurred in the center of the mesh with severe adhesions to the mesh and tacker. Conclusion: Five years of follow-ups showed 11% recurrence in the same site note, which needs to be reviewed. Further, 10 years of follow-up results need to be assessed.

Diabetic Foot, Conservative Management.

Diabetic foot ulcers are serious complications of Diabetes Mellitus and are known to be resistant to conventional treatment; they may herald severe complications and may lead to lower limb amputation if not treated wisely. Objectives: To assess the efficacy of conservative management and LowLevel Laser Therapy (LLLT) in the treatment of diabetic foot ulcers. Setting: Baghdad Teaching Hospital. Time, from January 2015 through April 2020. Patients and methods: A prospective randamised study included (45) patients who were proved to have a diabetic foot ulcer, the ulcers were graded according to Wagner classification into six grades from (0 to 5), and patients with Wagner grades 1, 2, and 3 were treated conservativly by wound cleaning, controlling of blood sugar in the ward and send for laser therapy. Results: There were six patients with grade 1 ulcers, and all of them (100%) showed complete healing over a period of 3 weeks of conservative treatment and laser therapy. Also, 22 patients out of 25 (88%) with grade 2 ulcers and 11 patients out of 14 (78.6%) with grade 3 ulcers showed complete healing in about six weeks of treatment. Forty-five patients were treated by laser, and only six patients (13.3%) showed minor complications (itching, numbness, erythema, or even blisters), which were reported after the 2nd. Weak of treatment. Conclusion: Diabetic foot ulcers are a common problem in Baghdad Teaching Hospital; it is most commonly occure in patients with long-standing uncontrolled diabetes. Conservatie treatment by wound cleaning, controlling of blood sugar, and laser therapy (LLLT) was proved to be effective in treating grade 1,2 and 3 ulcers and decreasing the time of ulcer healing

Management of Chronic Non-Healing Ulcers by Topical Application of Platelet Rich Plasma (PRP)

Disturbance of the normal anatomic structure and functional integrity of the skin can be described as wound. Chronic or non-healing ulcers are defined as ulcers which are failed to heal in less than 3 weeks of duration .If normal healing process is interrupted ulcer can become chronic in nature due to lack of growth factors and cytokines which is results in delay of wound healing. Conventional treatment for chronic non-healing ulcers includes wound cleansing and necrotic tissue debridement. The use of patient’s own body cells for ulcer treatment relies upon the components present in the blood and platelet concentrate, which contains various cytokines and growth factors. Autologous PRP is a platelet suspension in plasma derived from whole blood that is increasingly being used in clinical practice for the treatment of chronic non healing ulcers. OBJECTIVE: To assess the efficacy of topical application of autologous platelet rich plasma in wound healings. METHODOLOGY: The study was conducted in the department of General Surgery, GREAT EASTERN MEDICAL SCIENCES during the period of February 2021 to February 2022 . Ten patients between 18-80 yrs ,of any sex, with chronic non-healing ulcers of different etiologies were treated with topical application of PRP. RESULTS : Ten patients each having ulcer of varying etiology were included .Treated with Topical administration of AUTOLOGOUS PRP solution over the ulcer. Among the included patients 6(60%) were males and 4 (40%) were females with a mean age of 62.5± 13.53 years. Out of 10 patients 4(40%) were in 61-80 years age group,2(20%)were in 41-60 years age group and 4(40%) patients was less than 40 years .The duration of the chronic non healing ulcers presented by the patients range from 9 to 24 weeks with a mean duration of 16weeks.After application of PRP solution ,the mean healing time was found to be almost 8.2 weeks±1.9weeks.After the application of PRP solution small islands of granulating tissue appeared over the wound and a significant reduction in ulcer size was observed as a sign of healing and improvement. CONCLUSION: In our study, the results showed that PRP is a safe and effective treatment modality for chronic non-healing ulcers. Delivering of growth factors to target site enhances the wound healing rates of chronic non healing ulcers.PRP seems to be efficient to treat chronic non healing ulcers which are non responsive to classical conservative treatments. Using PRP to treat chronic wounds/ulcers may not only enhance healing, but also prevent lower extremity amputations caused by nonhealing wounds.There by reducing over all hospital stay, inconvenience of constant medication and morbidity.

THE CONCEPTUAL STUDY ON YANTRA: A REVIEW

Yantras are inevitable parts of all minor and major surgical procedures. In surgeries and even in wound cleaning, we need yantras to take a sterilised gauze piece. This article throws light on the ancient yantras which have been used in the olden days. An attempt has been made to compile the Yantras mentioned in the Sushruta Samhita and Ashtanga Hridaya. The different types of yantras, like Swastika yantra, Samdamsa yantra, Tala yantra, Nadi yantra, and Upayantra, are being told in this article in addition to those mentioned in Ashtanga Hridaya.

Absorbable mesh in a contaminated field: hernia repair outcomes.

Hernia repair mesh aids in the stability of incisional hernia repair and can reduce the need for subsequent operations. There is, however, debate among surgeons over which type of hernia mesh-synthetics, biologics, or biosynthetics-is indicated as best for specific patients. A retrospective case review comparing surgical outcomes based on wound class and mesh materials may provide insights into this question. This study evaluates patient outcomes using biosynthetic mesh based upon CDC wound classification. Following Institutional Review Board approval, the local National Surgery Quality Improvement (NSQIP) databases were queried for open ventral hernia repaired with absorbable mesh implants from January 2013-December 2017. Factors for comparison included patient demographics, operative details, and an analysis of clinical outcomes. Our study identified 112 ventral hernia repair cases with absorbable mesh placement, 32% (n = 36) were wound classes II-IV. Higher wound class correlated statistically with diabetes (33.3%), prior hernia repair (61.1%), and parastomal hernia (44.4%). Higher wound classes were associated with more emergent presentations, involved bowel resection more frequently, required larger mesh implants, increased post-operative surgical site infections, and wound disruption. Increasing wound class was also associated with longer hospital stays and greater need for readmission (38.9% vs. 11.8%). Compared to patients with clean wounds, biosynethic mesh repair patients with contaminated wounds exhibited more emergent presentations, increased incidence of bowel resection, increased mesh size, and more readmissions. Despite these peri-operative outcomes, hernia recurrence rates among biosynethic mesh hernia repair were similar in CDC class II-IV patients as class I.

IWII Wound Infection in Clinical Practice consensus document: 2022 update

Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

Hyperglycaemia-Linked Diabetic Foot Complications and Their Management Using Conventional and Alternative Therapies

Diabetes mellitus, a major cause of mortality around the globe, can result in several secondary complications, including diabetic foot syndrome, which is brought on by diabetic neuropathy and ischemia. Approximately 15% of diabetic patients suffer from diabetic foot complications, and among them 25% are at risk of lower limb amputations. Diabetic foot ulcers are characterized as skin lesions, gangrene, or necrosis, and may develop due to several reasons, including hyperglycemia and slower wound healing in diabetic patients. A management protocol involving wound cleaning, oral antibiotics, skin ointments, and removing dead tissue is currently followed to treat diabetic foot ulcers. In severe cases, amputation is performed to prevent the infection from spreading further. The existing therapy can be costly and present adverse side effects. Combined with a lack of vascular surgeons, this ultimately results in disability, especially in developing nations. There is a growing interest in the use of alternative therapies, such as medicinal plants, to discover more efficient and affordable treatments for diabetic foot syndrome. It has been observed that treatment with numerous plants, including Carica papaya, Annona squamosa, Catharanthus roseus, and Centella asiatica, promotes wound healing, reduces inflammation, and may decrease the number of amputations. However, little information is currently available on the prevention and management of diabetic foot ulcers, and additional research is necessary to completely understand the role of alternative therapies in the treatment of diabetic foot complications.

Autologous bone fragments for skull reconstruction after microvascular decompression

BackgroundVarious methods are used to reconstruct the skull after microvascular decompression, giving their own advantages and disadvantages. The objective of this study was to evaluate the efficacy of using autologous bone fragments for skull reconstruction after microvascular decompression.MethodsThe clinical and follow-up data of 145 patients who underwent microvascular decompression and skull reconstruction using autologous bone fragments in our hospital from September 2020 to September 2021 were retrospectively analyzed.ResultsThree patients (2.06%) had delayed wound healing after surgery and were discharged after wound cleaning. No patient developed postoperative cerebrospinal fluid leakage, incisional dehiscence, or intracranial infection. Eighty-five (58.62%) patients underwent follow-up cranial computed tomography at 1 year postoperatively, showed excellent skull reconstruction. And, the longer the follow-up period, the more satisfactory the cranial repair. Two patients underwent re-operation for recurrence of hemifacial spasm, and intraoperative observation revealed that the initial skull defect was filled with new skull bone.ConclusionThe use of autologous bone fragments for skull reconstruction after microvascular decompression is safe and feasible, with few postoperative wound complications and excellent long-term repair results.

Early outcomes following elective laminoplasty: A comparison of surgical specialties using the National surgical Quality Improvement Program (NSQIP) database

Study designRetrospective cohort study. ObjectiveThe objective of this study was to compare early outcomes in patients following cervical laminoplasty based upon surgeons’ specialty and compare preoperative comorbidities and operative characteristics. Summary of background dataCervical laminoplasty is a common procedure in patients presenting with cervical myelopathy secondary to spinal stenosis. Given this, it is routinely performed by both neurosurgeons and orthopedic spine surgeons. Surgeons’ training in different specialties could play a role in patients’ related outcomes when performing the same procedure. MethodsA retrospective review was conducted using the National Surgical Quality Improvement Program (NSQIP) database of all patients undergoing elective cervical laminoplasty identified by CPT code 63,050 and 63051. Preoperative demographics and comorbidities were evaluated. Following this, operative characteristics and complication rates were compared. Propensity score matching was used to adjust confound variables for the rate of complications. ResultsA total of 2708 cases were analyzed from the NSQIP database that met the inclusion criteria. Of these, there were 1143 cases in the orthopedic surgery cohort and 1565 cases in the neurosurgery cohort. Neurosurgery patients have a higher rate of preoperative dyspnea, hypertension, ASA class of 3 or more, and lower rates of clean wound class. Orthopedic surgery patients were more likely to have a longer operation time, while neurosurgery patients demonstrated a longer length of stay. Following propensity matching for comorbidities, neurological surgery patients were more likely to have unplanned readmissions, wound dehiscence, and pulmonary emboli (p < 0.05). ConclusionsIn conclusion, cervical laminoplasty is a safe and effective procedure when conducted by both orthopedic spine surgeons and neurosurgeons. In our series, neurosurgical patients were more likely to have higher rates of preoperative comorbidities and higher complication rates.